I have polycystic ovary syndrome (PCOS)… Why should I think about exercise?
In a nutshell – what is PCOS?
PCOS is one of the most common endocrine conditions, affecting about 8-13% of reproductive aged women with up to 70% of affected women remaining undiagnosed. PCOS is a significant public health issue with reproductive, metabolic and psychological features. Some features that females with PCOS present with can be psychological, reproductive and metabolic. Longer term health risks include: type 2 diabetes, obesity, infertility and cardiovascular disease.
The symptoms vary between individuals and their life stages, but may include:
- Irregular or absent menstrual cycles
- Hirsutism and/or alopecia
- Acne that may be severe
- Obesity & weight management problems
- Infertility
- Emotional challenges (distress, depression and/or anxiety; low self-esteem; poor body image and health related quality of life).
- Insulin resistance and increased risk of diabetes with earlier onset
- Cardiovascular risk factors
I have been diagnosed or suspect I might have it – why should I consider exercise?
With PCOS being a metabolic condition, exercise plays a key role in managing this condition and reducing the risk of long term health consequences. It also generally has no side effects when compared with pharmacotherapy! See below some of the ways it can help:
Fertility and menstrual cycle regulation: The evidence tells us that 5-10% of weight loss may assist in cycle control and fertility and therefore weight loss is considered a first line treatment for anyone with a BMI greater than 25kg/m2. It also tells is that education alone and setting unachievable goals are generally unsuccessful; therefore, we must encourage simple behaviour change through prioritising a healthy lifestyle and setting small, achievable goals with the correct support.
Reducing chronic disease risk: Exercise helps us to manage our cardiometabolic health (including blood pressure, lipids), which can reduce the risk of developing secondary conditions later in life. Women with PCOS have a 3-5 fold increased risk of developing gestational, pre-diabetes and type 2 diabetes later in life, and this also occurs in young, lean women. Exercise helps your body to process glucose (a recent study found exercise was able to influence insulin sensitivity by 13%), which can help to reduce our risk.
Mental and emotional health: In women with PCOS, there is a high prevalence of moderate to severe anxiety and depressive symptoms. Exercise can assist with managing anxiety and depressive symptoms, along with negative body image and low self-esteem (which is highly prevalent in these women).
Weight management: It is important to note that 40% of women with PCOS don’t have a weight management issue, but for some this will be important. Exercise, along with nutrition support is key in managing weight and as outlined above, this has a positive effect for fertility and reducing chronic disease risk.
How much exercise is recommended?
There is a difference between structured exercise and being physically active. We know that reducing sedentary behaviour and increasing incidental activity can help to improve metabolism, so trying to break up long periods of sitting and taking opportunities to increase your movement throughout the day can be a great place to start. Remember, physical activity can include transportation such as walking or cycling, occupational work, household shores, games, sports or planned exercise, and leisure time activity. You might find self-monitoring with a fitness tracker or step counter useful to keep you accountable and on track. We want to aim for 10000 steps per day if this is possible (including 30mins structured exercise equally around 3000 steps).
Structured exercise is also important because it gives us additional health and fitness benefits. In adults, a minimum of 150 minutes per week of moderate intensity exercise (or 75 minutes of vigorous intensity exercise) is recommended in addition to muscle strengthening on two non-consecutive days per week. In adolescents, a minimum of 60 minutes of moderate to vigorous intensity exercise with strength exercise at least three times per week is recommended. This activity can be performed in at least 10-minute bouts or ~1000 steps, aiming to achieve at least 30 minutes on most days of the week. It is important to note that moderate intensity exercise is where you get a little puff, but can still talk, so it doesn’t have to be anything too elaborate.
There is some evidence that vigorous exercise can reduce risk compared to moderate intensity, however more research needs to be done in this space. It is also important to note that for someone with PCOS, ‘overdoing’ exercise (e.g., lots of high intensity exercise all the time) can act as a chronic stressor which can actually contribute to PCOS symptoms (because PCOS is a hormonal condition and anything that disrupts hormonal balance can have a negative impact). Therefore, restorative exercise is often an important part of treatment and HIIT every day is definitely not the answer.
For modest weight loss, the prevention of weight re-gain and greater health benefits, the guidelines recommend a minimum of 250 minutes per week of moderate intensity exercise, or 150 minutes per week of vigorous intensity, with muscle strengthening activities on 2 non-consecutive days. Don’t be alarmed if this seems like a lot or unachievable, the guidelines also state that doing something is better than doing nothing! We don’t want to progress your exercise more than 5% per week to give your body time to adapt.
Why should I consider a referral to an exercise physiologist?
Exercise physiologists can be a great source of support, accountability and education moving forward with increasing your activity. We can provide behaviour change counselling and setting of realistic goals. We can also help you overcome exercise barriers, some of which are more specific to PCOS including confidence, fear of injury and physical limitations. We can also help to shift your focus from weight and BMI to other variables such as body composition, having more energy and feeling better – this can allow you to get lots of health benefits in a much more positive light.
Not sure where to start? I’d love to help you work out a plan. Give us a call on 3325 3678 or book your Gap Free Assessment on the website!
Tamika Hassum
Accredited Exercise Physiologist
Special interest in women’s health including PCOS
To read more, visit:
http://exerciseismedicine.com.au/wp-content/uploads/2020/10/EIM-fact-sheet_PCOS_Professional.pdf